Endocrine Abstracts

Background: Patient Safety Noticed issued by Welsh Government in June 2021 set out multiple action plans to be implemented by Welsh health boards to improve recognition and management of adrenal crisis. Hospitals were advised to review policies to ensure all patients at risk of Adrenal Crisis [(primary/secondary/tertiary adrenal insufficiency (AI)] were identified.

Aim: In response, our hospital commenced a quality improvement project seeking to better equip doctors to identify patients at risk of AI and ensure optimal communication of sick-day steroid rules to patients.

Methods: Teaching series was initiated to provide updated information to steroid prescribing specialties, including medical meetings and targeted teaching to Respiratory, Acute Medicine and Endocrinology departments, who frequently encounter patients at risk. Poster highlighting salient findings from patient safety alert was distributed throughout the hospital reinforcing teaching sessions. The poster included QR code enabling access to written sick-day steroid rules produced by the Society for Endocrinology, allowing patient distribution. Anonymised questionnaires provided to hospital doctors at 3 monthly intervals were analysed to review self-assessed clinical practice. Questions related to written and verbal communication of sick-day steroid rules, use of steroid cards and individual’s self-judged confidence managing AI.

Results: Results demonstrated increase in questionnaire ratings of ‘always’/‘sometimes’ for providing verbal and written communication of sick-day steroid rules of 55% and 48.87% respectively between initial and end results. Increase of 42.9% in ratings for ‘always’/‘sometimes’ providing steroid cards was also observed at end point. Self-judged rating of confidence managing AI increased from 32.1% from beginning of project to 88.89% at final questionnaire.

Conclusion: Data analysis demonstrates improvement in communication of sick-day steroid rules, use of steroid cards and confidence managing AI in relation to the project. Limitations included the subjective nature of questionnaires and regular change of departmental junior workforce during the timeframe.